Treatment as prevention: are Argentinean HIV care providers willing to adopt earlier antiretroviral therapy?

MEDICAL education; CROSS infection prevention; ANTIRETROVIRAL agents; ACADEMIC medical centers; ATTITUDE (Psychology); BLOOD testing; CONFIDENCE intervals; HIV infections; HIV-positive persons; MEDICAL quality control; MEDICAL personnel; MEDICAL protocols; MULTIVARIATE analysis; PREVENTIVE health services; SEX distribution; SURVEYS; VIRAL load; EARLY medical intervention; DATA analysis software; DESCRIPTIVE statistics; ODDS ratio

HIV guidelines increasingly recommend antiretroviral therapy (ART) initiation at a higher CD4 levels. The extent to which these evolving standards are translated into routine clinical care has not been evaluated in Argentina. During October 2012, we conducted an online survey among Argentinean HIV clinicians to assess their attitudes and practices toward ART initiation and its potential use for HIV prevention. Of the 280 physicians included, 61% would prescribe ART at CD4 ≤500 cells/µL for asymptomatic patients. Although, only 11% would recommend ART irrespective of CD4 cell count, 72% would do it for serodiscordant couples, and 75% for sex workers. Most participants agreed that they would consider earlier initiation of ART if transmission risk exists, and that expansion of ART could help decrease HIV incidence. These results suggest that a large proportion of Argentinean HIV care providers are willing to adopt the recently updated Argentinean guidelines recommending earlier ART, especially when high HIV transmission risk exists. [ABSTRACT FROM AUTHOR]